Former Railroad Employee Sentenced to Two and a Half Years in Federal Prison for Fraudulently Obtaining Disability Benefits
CHICAGO — The husband-and-wife owners of a Chicago home-healthcare business paid kickbacks to employees and marketers in exchange for referring elderly and disabled patients to the company for unnecessary or non-existent treatment that was funded by Medicare, according to a 23-count federal indictment unsealed today.
HCN Home Healthcare Inc., through its owners, ESTRELLITA DUQUILLA and MIGUEL DUQUILLA, paid kickbacks to employees and marketers to induce the referral of Medicare beneficiaries to HCN, according to the indictment. The indictment further contends that HCN employees altered nursing reports and patient files to falsely create the appearance that its patients qualified for in-home treatment. As a result of the kickback and fraudulent billing scheme, Medicare made overpayments to HCN in excess of $6 million, according to the indictment.
The Duquillas, of Des Plaines, were each charged with conspiracy to pay and receive healthcare kickbacks. Also charged in the conspiracy were four employees of HCN and an outside marketer who is married to an HCN nurse.
The indictment comes amid a lengthy federal investigation that included the execution of a search warrant at HCN’s office. The investigation was carried out by the Medicare Fraud Strike Force, which consists of agents from the Federal Bureau of Investigation and the U.S. Department of Health and Human Services, and prosecutors from the U.S. Attorney’s Office and the Justice Department’s Fraud Section. The strike force is part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative between the Department of Justice and HHS to prevent fraud and to enforce anti-fraud laws around the country.
In addition to the kickback conspiracy charge, Estrellita Duquilla, 58, was charged with five counts of paying kickbacks to induce referrals of Medicare beneficiaries. Miguel Duquilla, 60, was charged with two counts of paying kickbacks to induce referrals of Medicare beneficiaries. The indictment also charges the Duqillas with one count of conspiracy to commit healthcare fraud, and ten counts of Medicare fraud. The Duquillas are the owners and operators of HCN, which is located at 6288 N. Cicero Ave. in Chicago. The indictment states that the fraud scheme spanned from 2008 to 2012.
According to the indictment, many of the beneficiaries were not qualified for home-health services, and in several instances never needed or received the care. In some cases, the employees and marketers paid cash to the patients in exchange for allowing the patients’ information to be used in paperwork submitted to Medicare, the indictment states.
One of HCN’s registered nurses, ZENAIDA DIMAILIG, 78, of Bensenville, solicited and received kickbacks from the Duquillas, in exchange for steering Medicare beneficiaries to HCN, according to the indictment. Dimailig is charged with one count of conspiracy to pay and receive healthcare kickbacks, and one count of conspiracy to commit Medicare fraud.
HCN’s Quality Assurance Nurse, GRACE MENDEZ, 59, of Des Plaines, put false information in patient files, such as the dates of non-existent nursing visits, knowing this information would be submitted to Medicare as a basis for seeking payments to HCN, according to the indictment. She is charged with one count of conspiracy to pay and receive healthcare kickbacks, two counts of knowingly and willfully soliciting and receiving a Medicare kickback, one count of conspiracy to commit healthcare fraud, and one count of Medicare fraud.
HCN’s Director of Nursing, DANIEL FAJARDO, 45, of Chicago, is charged with one count of conspiracy to pay and receive healthcare kickbacks, and one count of conspiracy to commit healthcare fraud. HCN’s nursing assistant, SHERROD HARRIS, 49, of Chicago, is charged with one count of conspiracy to pay and receive healthcare kickbacks, and two counts of knowingly and willfully soliciting and receiving a healthcare kickback.
In addition to the HCN employees, an outside marketer was also charged in the scheme. ROBERTO JONSON, 58, of Bensenville, was the owner of Berzen Home Care Services Inc., a now-defunct company that was based out of his home. The charges allege that Jonson, who is Dimailig’s husband, received payments from the Duquillas in exchange for referring non-homebound Medicare beneficiaries to HCN. Jonson is charged with one count of conspiracy to pay and receive healthcare kickbacks, and one count of conspiracy to commit healthcare fraud.
The indictment was returned last week and unsealed today in advance of the arraignments of Harris and Mendez, which were scheduled for 11:00 a.m. today before U.S. Magistrate Judge Michael T. Mason. The arraignments of the other defendants will be scheduled by the Court at a later date.
The indictment was announced by Zachary T. Fardon, United States Attorney for the Northern District of Illinois; John A. Brown, Acting Special Agent-in-Charge of the Chicago Office of the Federal Bureau of Investigation; and Lamont Pugh III, Special Agent-in- Charge of the Chicago Regional Office of the U.S. Department of Health and Human Services Office of Inspector General.
The investigation is ongoing, the officials said.
The healthcare fraud conspiracy and the Medicare fraud counts carry a maximum penalty of ten years in prison and a $250,000 fine. The kickback and kickback conspiracy counts are punishable by up to five years in prison and a $250,000 fine. If convicted, restitution is mandatory and the court must impose a reasonable sentence under federal statutes and the advisory United States Sentencing Guidelines. The public is reminded that an indictment is not evidence of guilt. The defendants are presumed innocent and are entitled to a fair trial at which the government has the burden of proving guilt beyond a reasonable doubt.
The government is being represented by Assistant U.S. Attorney Renai S. Rodney and Justice Department Senior Trial Attorney Jon M. Juenger.
To report health care fraud or to learn more about the Health Care Fraud Prevention & Enforcement Action Team (HEAT), logon to: StopMedicareFraud.gov.